BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 804
                                                                  Page  1

          Date of Hearing:  June 27, 2012

                       ASSEMBLY COMMITTEE ON LOCAL GOVERNMENT
                                Cameron Smyth, Chair
                     SB 804 (Corbett) - As Amended:  June 6, 2012

           SENATE VOTE  :  22-13
           
          SUBJECT  :  Health care districts: transfers of assets.

           SUMMARY  :  Requires health care districts, when transferring 50% 
          or more of the district's assets to a nonprofit corporation, to 
          include in the transfer agreement the appraised fair market 
          value from an independent consultant, as specified, and adds in 
          several other requirements related to transfer agreements.  
          Specifically,  this bill  :   

          1)Requires health care districts, when transferring 50% or more 
            of the district's assets, to include in the transfer agreement 
            the appraised fair market value from an independent consultant 
            with expertise in methods of appraisal and valuation and in 
            accordance with applicable governmental and industry standards 
            for appraisal and valuation.

          2)Requires the appraisal included within the transfer agreement 
            that is used to determine the fair market value to be 
            performed within six months preceding the date on which the 
            district approves the transfer agreement.

          3)Requires the resolution submitted to the voters before the 
            district transfers 50% or more of the district's assets to 
            identify the asset proposed to be transferred, its appraised 
            fair market value, and the full consideration that the 
            district is to receive in exchange for the transfer.

          4)Provides that the bill's provisions shall only apply to 
            transfers made on or after the effective date of the 
            legislation.

           EXISTING LAW  :

          1)Establishes the Local Health Care District Law which 
            authorizes communities to form special districts to construct 
            and operate hospitals and other health care facilities to meet 
            local needs.








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          2)Authorizes a health care district to transfer, for the benefit 
            of the communities served by the district, any part of its 
            assets of the district to one or more nonprofit corporations 
            to operate and maintain the assets.  Prior to the district 
            transfer, requires the district board to submit a measure to 
            the voters of the district proposing the transfer.

          3)Authorizes a district to transfer, at less than fair market 
            value, any part of the assets of the district to one or more 
            nonprofit corporations to operate and maintain the assets, if 
            the transfer benefits the communities served by the district.  
            Requires that for a transfer of 50% or more of a district's 
            assets to be deemed to benefit a district's communities, a 
            district must:

             a)   Fully discuss the transfer agreement in at least five 
               properly noticed public meetings before the district 
               board's decision to transfer the assets;

             b)   Provide in the transfer agreement that the district must 
               approve all initial board members of the nonprofit 
               corporation and any subsequent board members as may be 
               specified in the transfer agreement;

             c)   Provide in the transfer agreement that specified assets 
               are to be transferred back to the district upon termination 
               of the transfer agreement;

             d)   Commit the nonprofit corporation, in the transfer 
               agreement, to operate and maintain the district's health 
               care facilities and its assets for the benefit of the 
               communities served by the district; and,

             e)   Require, in the transfer agreement, that any funds a 
               corporation receives from the district be used only for 
               specified activities that would further a valid public 
               purpose if undertaken directly by the district.

          4)Requires the district to report to the California Attorney 
            General (AG), within 30 days of any lease of district assets 
            to one or more corporations, the type of transaction and the 
            entity to whom the assets were leased.

           FISCAL EFFECT  :  None








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           COMMENTS  :   

          1)SB 1771 (Russell and Kopp), Chapter 1359, Statutes of 1992, 
            defines the terms and conditions under which a district may 
            transfer any part of its assets to one or more nonprofit 
            corporations, including the requirement that the transfer must 
            be for the benefit of the community served by the district, 
            provides for the transfer back to the district of the assets 
            at the end of the lease, and requires approval by a majority 
            of the voters in the district if the transfer is of 50% or 
            more of the district's assets.

          2)Districts were formed under state law to meet local health 
            needs not satisfied by other health care resources or 
            government programs in a given geographical area.  Districts 
            formed pursuant to state law are financed by assessments on 
            real and personal property within the district.  A 2006 report 
            published by the California HealthCare Foundation found that 
            85 health care and hospital districts have been formed in 
            California since the first hospital district enabling 
            legislation was passed in 1946.

          Districts operate medical facilities, including hospitals, 
            public health clinics, and skilled nursing facilities.  Some 
            also provide community-based education programs to the 
            residents of their districts.  Given the volatile health care 
            market in recent decades, districts have contemplated service 
            changes, leasing arrangements, and affiliations with both 
            nonprofit and for-profit health care corporations as a means 
            of providing health care services to residents.

          Responding to changes in health care delivery, districts explore 
            economic and organizational alternatives, including leasing or 
            selling their assets to nonprofit corporations or even to 
            for-profit companies.  If a district wants to transfer 50% or 
            more of its assets to any corporation, the transfer needs 
            majority-voter approval from the district board.
          3)According to the author, this bill is intended to provide the 
            public with more information about the value of district 
            assets that are proposed to be sold or transferred to one or 
            more corporations for less than fair market value.  The author 
            argues that unfortunately, in too many cases, these transfer 
            agreements end with assets being transferred out of the 
            district to the benefit of the contracting private corporation 








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            and to the detriment of the local community.  The author 
            maintains that of the 85 districts that have been formed since 
            1945, almost a third have closed, leased, or sold their 
            hospitals.  Some, according to the author, have declared 
            bankruptcy and many have changed or expanded their historic 
            role as providers of acute care.  This bill, the author 
            asserts, addresses the growing concern that some districts are 
            entering into contracts that reduce the district's assets and 
            financial security.

          4)This is not the first attempt at requiring further information 
            as part of the transfer agreement for health care districts:  

              a)   SB 134 (Corbett, 2011), was substantially similar to the 
               provisions of this bill.  SB 134 was amended to delete 
               these provisions in the Assembly.

             b)   SB 1240 (Corbett, 2010), would have imposed conditions 
               on contracts between districts and other entities to 
               operate one or more health facilities owned by the 
               district.  SB 1240 was vetoed by Governor Arnold 
               Schwarzenegger, who stated that SB 1240 would have limited 
               the discretion of a district when entering into a contract 
               with another operating entity and would have created the 
               unintended consequence of reducing the incentive for such 
               arrangements when hospitals are struggling to remain open.

             c)   SB 1351 (Corbett, 2008), would have required voter 
               approval before a district can transfer, for the benefit of 
               the communities served by the district and in the absence 
               of adequate consideration, any part of the assets of the 
               district to one or more nonprofit corporations to operate 
               and maintain the assets, as opposed to 50% or more of the 
               district's assets.  SB 1351 would have also expanded the 
               AG's ability to review and comment on proposed transfers 
               and prohibited a district from relinquishing its membership 
               on the board of a nonprofit corporation to which the 
               district has transferred or leased its assets without a 
               vote of the district electorate.  SB 1351 was vetoed by 
               Governor Arnold Schwarzenegger, who stated that he could 
               not support placing additional restrictions on a district, 
               especially when they are elected by, and accountable to, 
               their local community.

             d)   SB 460 (Kelley), Chapter 18, Statutes of 1998, 








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               permitted, until 2001, a district to transfer at fair 
               market value its assets to for-profit corporations, as 
               specified.

             e)   SB 1508 (Figueroa), Chapter 169, Statutes of 2000, 
               extended the authority for districts to transfer or lease 
               assets to a for-profit until January 1, 2006.

             f)   AB 1131 (Torrico), Chapter 194, Statutes of 2005, 
               extended the January 1, 2006, sunset date to 2011, 
               permitting districts to transfer or lease assets to 
               for-profit corporations, as specified.


           5)Support arguments  :  The California Nurses Association (CNA) 
            writes in support that this bill gives the public important 
            information about the value of health care district assets 
            that are proposed to be transferred to an outside entity for 
            less than market value.  CNA maintains that this information 
            is crucial because health care district assets are public and 
            are owned by the residents of the health care district.  

            Opposition arguments  :  None on file.

          6)This bill was double-referred to the Assembly Health Committee 
            and heard on June 12, 2012.  The bill passed on a 14-4 vote.
             
          REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Nurses Association
           
            Opposition 
           
          None on file

           Analysis Prepared by  :    Debbie Michel / L. GOV. / (916) 
          319-3958